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Drug Trend · Rheumatology · Gastroenterology
Every Medicare Part B payment limit CMS has published for J0717 — 51 quarters since Q1 2014, about 13 years of pricing on one axis. Public CMS data with our change framing; no contracted rates.
The smallest Part B line of the IPAY-2028 five, because most certolizumab use is the self-injected syringe under Part D — the supervision restriction is written into J0717's own descriptor, limiting Part B payment to physician-administered vials. No biosimilar exists or is near market: the PEGylated molecule has kept the pipeline empty, so 2028's negotiated price arrives with no competitive escape hatch.
CMS payment limit (ASP + 6% basis) by quarter, as published.
At the Q3 2026 limit of $3.444 per 1 mg, the implied ASP is about $3.249 and the on-paper add-on is $0.195 per 1 mg. After the 2% sequester on Medicare’s 80% share, the effective add-on is roughly 4.3% of ASP — about $0.14 per 1 mgwhen the full allowable is collected. Whether that covers your carrying cost, waste, and denials depends on your acquisition price against ASP — which is exactly the number the payment limit can’t see, and the comparison the practice X-Ray runs with your actuals.
Dose math. 400 mg — given as two 200 mg SC injections — at weeks 0, 2, 4, then 400 mg every 4 weeks maintenance (Crohn's; RA also allows 200 mg q2w); 400 mg = 400 billing units (1 mg/unit). At the Q3 2026 limit of $3.444 per 1 mg, a typical 400-unit dose carries a Medicare allowable of about $1,377.60 — Medicare pays ~$1,080.038 after the sequester, and ~$275.52 rides on coinsurance collection. Part B spent $401.2 million on J0717 in 2023 across 24,332 beneficiaries (CMS Part B drug-spending data).
Administration. 96372 ×2 — two separate 200 mg subcutaneous injections per 400 mg dose, each separately reportable.
Waste modifiers. Single-dose container — JW (documented discard) / JZ (no waste) modifiers required since July 2023. Run your own numbers on the buy-and-bill calculator.
The coding & patient-cost side. For billing references across 370+ drugs (dosing conversions, modifiers, payer policies, patient cost), see CareCost Estimate’s drug library, our billing-reference sister site.
Where J0717stands in the national payers’ published sourcing programs (the office-vs-hospital setting distinction most coverage misses):
State law is the other half: the white-bagging laws-by-state tracker — 11 states currently ban payer sourcing mandates outright.
All 51 published quarters for J0717, newest first, as published per file version.
| Quarter | Limit ($/1 mg) | QoQ |
|---|---|---|
| Q3 2026 | 3.444 | -9.1% |
| Q2 2026 | 3.79 | -2.0% |
| Q1 2026 | 3.867 | -1.2% |
| Q4 2025 | 3.913 | -12.8% |
| Q3 2025 | 4.486 | +12.6% |
| Q2 2025 | 3.984 | +2.2% |
| Q1 2025 | 3.898 | -16.2% |
| Q4 2024 | 4.652 | +4.4% |
| Q3 2024 | 4.456 | -3.6% |
| Q2 2024 | 4.624 | -4.0% |
| Q1 2024 | 4.816 | -1.7% |
| Q4 2023 | 4.90 | -3.4% |
| Q3 2023 | 5.073 | +2.1% |
| Q2 2023 | 4.971 | -1.8% |
| Q1 2023 | 5.061 | -6.5% |
| Q4 2022 | 5.41 | -3.1% |
| Q3 2022 | 5.581 | -1.0% |
| Q2 2022 | 5.638 | -10.2% |
| Q1 2022 | 6.275 | +0.0% |
| Q4 2021 | 6.272 | -3.8% |
| Q3 2021 | 6.523 | -19.2% |
| Q2 2021 | 8.076 | -1.3% |
| Q1 2021 | 8.182 | +0.3% |
| Q4 2020 | 8.161 | -1.4% |
| Q3 2020 | 8.276 | +3.6% |
| Q2 2020 | 7.987 | -2.7% |
| Q1 2020 | 8.207 | +2.3% |
| Q4 2019 | 8.023 | -1.3% |
| Q3 2019 | 8.132 | +3.3% |
| Q2 2019 | 7.872 | -0.2% |
| Q1 2019 | 7.889 | -2.7% |
| Q4 2018 | 8.109 | +1.1% |
| Q3 2018 | 8.023 | +3.7% |
| Q2 2018 | 7.737 | -2.5% |
| Q1 2018 | 7.934 | +6.3% |
| Q4 2017 | 7.467 | -3.2% |
| Q3 2017 | 7.713 | +4.4% |
| Q2 2017 | 7.39 | -0.5% |
| Q1 2017 | 7.427 | +4.4% |
| Q4 2016 | 7.111 | +0.7% |
| Q3 2016 | 7.061 | +8.8% |
| Q2 2016 | 6.488 | +0.3% |
| Q1 2016 | 6.468 | -2.4% |
| Q4 2015 | 6.624 | +10.6% |
| Q3 2015 | 5.988 | -1.0% |
| Q2 2015 | 6.048 | -2.0% |
| Q1 2015 | 6.172 | +0.0% |
| Q4 2014 | 6.17 | -5.4% |
| Q3 2014 | 6.525 | +6.7% |
| Q2 2014 | 6.117 | +19.2% |
| Q1 2014 | 5.131 | — |
Cimzia (certolizumab pegol) is billed to Medicare Part B under HCPCS code J0717, with a billing unit of 1 mg. Total billed units depend on the administered dose.
400 mg — given as two 200 mg SC injections — at weeks 0, 2, 4, then 400 mg every 4 weeks maintenance (Crohn's; RA also allows 200 mg q2w); 400 mg = 400 billing units (1 mg/unit). Administration is billed separately: 96372 ×2 — two separate 200 mg subcutaneous injections per 400 mg dose, each separately reportable.
At the Q3 2026 limit, a typical 400-unit dose carries an allowable of about $1,377.60. Medicare pays roughly $1,080.038 (80% less the 2% sequester) and the remaining ~$275.52 is patient or secondary coinsurance the practice still has to collect — before any administration revenue.
Yes. Cimzia ships in single-dose containers, so since July 2023 CMS requires the JW modifier for documented discarded amounts and the JZ modifier when there is no waste. Missing modifiers are a common audit and denial trigger on this code.
$3.444 per 1 mg, effective July 1, 2026, per the CMS July 2026 ASP pricing file. That is down 9.1% from the prior quarter and down 23.2% year over year.
The archive holds 51 quarters for J0717, starting at $5.131 per 1 mg in Q1 2014. The all-time peak was $8.276 in Q3 2020; the current limit is $3.444.
The payment limit is set at ASP + 6% (currently implying an ASP of about $3.249 per 1 mg). After the 2% sequester on Medicare's 80% share, the effective add-on is roughly 4.3% — about $0.14 per 1 mg — when the full allowable is collected.
Yes — certolizumab pegol is on the IRA's IPAY-2028 selected-drug list, one of the five Part B drugs in the first negotiation cycle ever to reach physician-administered drugs. CMS announces the negotiated Maximum Fair Price by November 30, 2026, and from January 1, 2028 the payment limit becomes 106% of MFP, replacing the ASP+6% basis for this drug.
Which limits moved this quarter, across all drugs: the ASP-change leaderboard. How this data is built and verified: the Data Desk. Billing reference (dosing, modifiers, admin CPTs): CareCost Estimate’s drug library.
carecostoptimizer.com/drugs/cimzia-j0717-asp-trend. Computed from the public-domain CMS ASP pricing files. Free to cite with attribution.Drug economics as of Q3 2026 (Medicare ASP basis)
The chart is the national price. The practice X-Ray runs J0717 against your acquisition cost, payer mix, and 835s — and prices the answer in dollars.